合并正常甲状腺功能病态综合征的危重患儿血清甲状腺激素水平与预后的关系分析  

Relationship between serum thyroid hormone level and prognosis in critically ill children with euthyroid sick syndrome

作　　者：陈相宏 郭莹 杨媛洁 罗黎力 李德渊[2,3] 乔莉娜 Chen Xianghong;Guo Ying;Yang Yuanjie;Luo Lili;Li Deyuan;Qiao Lina(West China School of Medicine,Sichuan University,Chengdu 610041,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children,Ministry of Education,West China Second Hospital,Sichuan University,Chengdu 610041,China;Department of Pediatric Intensive Care,West China Second Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西临床医学院,成都610041 [2]四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]四川大学华西第二医院儿童重症医学科,成都610041

出　　处：《中国小儿急救医学》2022年第11期886-890,共5页Chinese Pediatric Emergency Medicine

基　　金：四川省科技计划项目(2019YFS0245)。

摘　　要：目的探讨合并正常甲状腺功能病态综合征(ESS)的危重患儿血清甲状腺激素水平与疾病预后的关系。方法回顾性收集2015年1月至2021年4月四川大学华西第二医院儿童重症医学科176例合并ESS重症患儿的临床资料及血清甲状腺激素水平。根据预后将患儿分为好转组和无效组,以及有基础疾病组和无基础疾病组,分别比较两组患儿甲状腺激素的差异。评估患儿入院后24 h内的第三代儿童死亡风险评分(PRISMⅢ),分析甲状腺激素水平与PRISMⅢ评分的相关性。结果176例合并ESS重症患儿中,最常见的疾病有脓毒症(31.8%)、重症肺炎(23.8%)、心力衰竭(10.7%);无效组患儿的游离T3(FT3)、T3、游离T4(FT4)、T4水平明显低于好转组(P<0.05),但两组患儿的促甲状腺激素(TSH)水平无明显差异(P>0.05)。FT3、T3、FT4、T4水平与PRISMⅢ评分呈负相关(r分别为-0.419、-0.459、-0.341、-0.383,P均<0.05),TSH水平与PRISMⅢ评分无相关性(P>0.05)。合并ESS重症患儿常见的基础疾病有:营养不良(31/98)、心脏疾病(30/98)、血液肿瘤(15/98)及支气管肺发育不良(10/98)。有基础疾病组患儿的中位年龄小于无基础疾病组(0.7岁比2.0岁,P<0.05);有基础疾病组预后为无效的患儿比例(24.5%)明显高于无基础疾病组(6.4%),差异有统计学意义(P<0.05);但两组患儿的FT3、T3、FT4、T4、TSH水平差异无统计学意义(P>0.05)。结论在重症儿童中多种疾病可导致ESS,以脓毒症最常见;有基础疾病的小年龄段重症患儿更应警惕ESS发生;患儿病情越重,FT3、T3、FT4、T4水平下降幅度越大,当低T3、T4、TSH同时出现时,可能提示患儿预后更差,甲状腺激素水平可作为评估危重患儿预后的指标,值得进一步研究。Objective To investigate the association between serum thyroid level and prognosis of critically ill children with euthyroid sick syndrome(ESS).Methods The clinical data and serum thyroid hormone levels of 176 children with ESS who were admitted to the Department of Pediatric Intensive Care Medicine at West China Second Hospital of Sichuan University from January 2015 to April 2021 were retrospectively collected.According to the prognosis,the children were divided into improved group and invalid group,as well as basic disease group and non basic disease group,and the differences of thyroid hormone between two groups were compared.The pediatric risk of mortalityⅢ(PRISMⅢ)scores within 24 hours of admission were assessed,and the correlation between thyroid hormone level and PRISMⅢscore was analyzed.Results Among 176 critically ill children with ESS,the most common diseases were sepsis(31.8%),severe pneumonia(23.8%)and heart failure(10.7%),respectively.The levels of free T3(FT3),T3,free T4(FT4)and T4 in invalid group were significantly lower than those in improved group(P<0.05),but there was no statistical difference in thyroid-stimulating hormone(TSH)level between two groups(P>0.05).The levels of FT3,T3,FT4 and T4 were negatively correlated with PRISMⅢscore(r=-0.419,-0.459,-0.341,-0.383,respectively,P<0.05),and there was no correlation between TSH level and PRISMⅢscore(P>0.05).The common underlying diseases of severe children with ESS were malnutrition(31/98),heart disease(30/98),hematologic neoplasms(15/98),and bronchopulmonary dysplasia(10/98).The median age of children in basic disease group was younger than that in non-basic disease group(0.7 years old vs.2.0 years old,P<0.05);The proportion of children with underlying diseases in invalid group was 24.5%,which was significantly higher than that of children without underlying diseases(6.4%),and the difference was statistically significant(P<0.05);There were no significant differences in the levels of FT3,T3,FT4,T4 and TSH between two groups(P>0.05).Conc

关 键 词：正常甲状腺功能病态综合征 危重症 甲状腺激素 预后 儿童 

分 类 号：R720.597[医药卫生—急诊医学] R725.8[医药卫生—儿科]